Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration

• Published in: European journal of radiology Vol. 80; no. 2; pp. 378 - 386
• Main Authors: Chou, Shinn-Huey, Wang, Zhen J, Kuo, Jonathan, Cabarrus, Miguel, Fu, Yanjun, Aslam, Rizwan, Yee, Judy, Zimmet, Jeffrey M, Shunk, Kendrick, Elicker, Brett, Yeh, Benjamin M
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.11.2011; Elsevier
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Contrast; Contrast Media - administration & dosage; Contrast media. Radiopharmaceuticals; Contrast-induced nephropathy; Creatinine - blood; Female; Humans; Injections, Intra-Arterial; Injections, Intravenous; Intra-arterial; Intravenous; Kidney - diagnostic imaging; Kidney Diseases - chemically induced; Kidney Diseases - diagnostic imaging; Male; Medical sciences; Middle Aged; Persistent enhancement; Pharmacology. Drug treatments; Radiology; Regression Analysis; Renal; Retrospective Studies; Tomography, X-Ray Computed; Triiodobenzoic Acids - administration & dosage; CT; Intravenous; Renal; Persistent enhancement; Contrast; Contrast-induced nephropathy; Intra-arterial; Kidney disease; Urinary system disease; Non ionic contrast media; Intravenous administration; Radiodiagnosis; Renal artery; Toxicity; Iodine Organic compounds; Kidney; Nephropathy; Urinary system; Medical imagery; Computerized axial tomography; Iodixanol; Comparative study; Contrast media
• DOI: 10.1016/j.ejrad.2011.02.044
• ISSN: 0720-048X

Abstract Purpose To examine the clinical significance of persistent renal enhancement after iodixanol administration. Methods We retrospectively studied 166 consecutive patients who underwent non-enhanced abdominopelvic CT within 7 days after receiving intra-arterial ( n = 99) or intravenous ( n = 67) iodixanol. Renal attenuation was measured for each non-enhanced CT scan. Persistent renal enhancement was defined as CT attenuation >55 Hounsfield units (HU). Contrast-induced nephropathy (CIN) was defined as a rise in serum creatinine >0.5 mg/dL within 5 days after contrast administration. Results While the intensity and frequency of persistent renal enhancement was higher after intra-arterial (mean CT attenuation of 73.7 HU, seen in 54 of 99 patients, or 55%) than intravenous contrast material administration (51.8 HU, seen in 21 of 67, or 31%, p < 0.005), a multivariate regression model showed that the independent predictors of persistent renal enhancement were a shorter time interval until the subsequent non-enhanced CT ( p < 0.001); higher contrast dose ( p < 0.001); higher baseline serum creatinine ( p < 0.01); and older age ( p < 0.05). The route of contrast administration was not a predictor of persistent renal enhancement in this model. Contrast-induced nephropathy was noted in 9 patients who received intra-arterial (9%) versus 3 who received intravenous iodixanol (4%), and was more common in patients with persistent renal enhancement ( p < 0.01). Conclusion Persistent renal enhancement at follow-up non-contrast CT suggests a greater risk for contrast-induced nephropathy, but the increased frequency of striking renal enhancement in patients who received intra-arterial rather than intravenous contrast material also reflects the larger doses of contrast and shorter time to subsequent follow-up CT scanning for such patients.